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2.
Br Dent J ; 228(11): 812-813, 2020 06.
Article in English | MEDLINE | ID: covidwho-629883
3.
Rev Esp Salud Publica ; 942020 Sep 07.
Article in Spanish | MEDLINE | ID: covidwho-746181

ABSTRACT

The SARS-CoV-2 pandemic (Covid-19) has had a major impact on residents of assisted-living facilities. While it is plausible that the characteristics of these patients and their special clinical fragility have contributed to their greater vulnerability to infection, other related factors cannot be ruled out, such as the quality of management at these centers and the lack of planning for actions taken before and during the health crisis. Both aspects pertain to the field of public health, where the ethics of the common good conflicts with the autonomy of the individual.


Subject(s)
Assisted Living Facilities/ethics , Community Health Planning/ethics , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health/ethics , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , Risk Factors , Spain/epidemiology
4.
Euro Surveill ; 25(35)2020 09.
Article in English | MEDLINE | ID: covidwho-745113

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends' gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied.


Subject(s)
Coronavirus Infections/transmission , Disease Outbreaks , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/transmission , Betacoronavirus , Coronavirus Infections/epidemiology , Disease Notification , Humans , Leisure Activities , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Spain/epidemiology
5.
Rev Esp Salud Publica ; 942020 Sep 03.
Article in Spanish | MEDLINE | ID: covidwho-743521

ABSTRACT

OBJECTIVE: The Covid-19 pandemic is testing the resistance of health systems, the preservation of health professionals is a priority in processes of this type. The professionals' exposure to suspicious contacts often requires their confinement. The objective was to know the epidemiological characteristics of the primary care professionals who required confinement. METHODS: The research was carried out in the North Metropolitan Primary Care Area of Barcelona, from February 17 to May 3, 2020. 1,418 professionals who required confinement due to the epidemic by Covid-19 participated. The reasons for confinement, symptomatology, the confinement time and the results of PCR tests results were recorded. Univariate descriptive analysis was performed. RESULTS: 78.8% of the professionals were women and the mean age was 45.2 years. 67.8% were doctors and nurses, in the remaining 32.2% there were different healthcare and non-care professionals. 64.1% of the sample presented symptoms compatible with Covid-19. Participants described multiple symptoms during confinement. 1,050 diagnostic RT- PCR tests were performed, being positive in 323 cases, of which 33 were in asymptomatic people. CONCLUSIONS: The impact of the epidemic by Covid-19 is anticipated in health personnel compared to the general population. The distribution of symptoms in healthcare professionals is similar to that of other studies in the general population. Of the total number of professionals requiring isolation, 22.7% confirmed the diagnosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Personnel , Occupational Diseases/epidemiology , Pneumonia, Viral/epidemiology , Primary Health Care , Quarantine , Adult , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Spain/epidemiology
6.
Epidemiol Infect ; 148: e189, 2020 08 26.
Article in English | MEDLINE | ID: covidwho-741656

ABSTRACT

Despite SARS-CoV-19 infection has a stereotypical clinical picture, isolated cases with unusual manifestations have been reported, some of them being well-known to be triggered by viral infections. However, the real frequency in COVID-19 is unknown. Analysing data of 63 822 COVID patients attending 50 Spanish emergency department (ED) during the COVID outbreak, before hospitalisation, we report frequencies of (myo)pericarditis (0.71‰), meningoencephalitis (0.25‰), Guillain-Barré syndrome (0.13‰), acute pancreatitis (0.71‰) and spontaneous pneumothorax (0.57‰). Compared with general ED population, COVID patients developed more frequently Guillain-Barré syndrome (odds ratio (OR) 4.55, 95% confidence interval (CI) 2.09-9.90), spontaneous pneumothorax (OR 1.98, 95% CI 1.40-2.79) and (myo)pericarditis (OR 1.45, 95% CI 1.07-1.97), but less frequently pancreatitis (OR 0.44, 95% CI 0.33-0.60).


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/complications , Myocarditis/complications , Pancreatitis/complications , Pericarditis/complications , Pneumonia, Viral/complications , Pneumothorax/complications , Betacoronavirus , Guillain-Barre Syndrome/virology , Humans , Myocarditis/virology , Pancreatitis/virology , Pandemics , Pericarditis/virology , Pneumothorax/virology , Spain/epidemiology
10.
PLoS One ; 15(8): e0238299, 2020.
Article in English | MEDLINE | ID: covidwho-732996

ABSTRACT

This paper seeks to determine which workers affected by lockdown measures can return to work when a government decides to apply lockdown exit strategies. This system, which we call Sequential Selective Multidimensional Decision (SSMD), involves deciding sequentially, by geographical areas, sectors of activity, age groups and immunity, which workers can return to work at a given time according to the epidemiological criteria of the country as well as that of a group of reference countries, used as a benchmark, that have suffered a lower level of lockdown de-escalation strategies. We apply SSMD to Spain, based on affiliation to the Social Security system prior to the COVID-19 pandemic, and conclude that 98.37% of the population could be affected. The proposed system makes it possible to accurately identify the target population for serological IgG antibody tests in the work field, as well as those affected by special income replacement measures due to lockdown being maintained over a longer period.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Return to Work/trends , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Coronavirus Infections/economics , Coronavirus Infections/mortality , Decision Making , Decision Trees , Humans , Infant , Infant, Newborn , Middle Aged , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/mortality , Spain , Young Adult
11.
PLoS One ; 15(8): e0238216, 2020.
Article in English | MEDLINE | ID: covidwho-729564

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1µg/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. MATERIAL AND METHODS: Single-center prospective cohort study. Between April 6th and April 17th 2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 µg/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. RESULTS: Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p<0.001). CONCLUSIONS: Patients with COVID-19 pneumonia and D-dimer values higher than 1 µg/mL presented a high prevalence of PE, regardless of clinical suspicion. We consider that these findings could contribute to improve the prognosis of patients with COVID-19 pneumonia, by initiating anticoagulant therapy when a PE is found.


Subject(s)
Coronavirus Infections/complications , Fibrin Fibrinogen Degradation Products/analysis , Pneumonia, Viral/complications , Pulmonary Embolism/virology , Aged , Betacoronavirus , Computed Tomography Angiography , Female , Humans , Male , Middle Aged , Pandemics , Prevalence , Prospective Studies , Pulmonary Embolism/diagnosis , Spain
12.
PLoS One ; 15(8): e0237960, 2020.
Article in English | MEDLINE | ID: covidwho-727328

ABSTRACT

BACKGROUND: In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. AIM: To determine clinical factors of a poor prognosis in patients with COVID-19 infection. DESIGN AND SETTING: Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. METHOD: Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. RESULTS: We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. CONCLUSION: Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Coronavirus Infections/mortality , Coronavirus Infections/virology , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Mortality , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Polymerase Chain Reaction , Prognosis , Protective Factors , Retrospective Studies , Risk Factors , Sex Factors , Spain/epidemiology , Young Adult
13.
Gac Med Mex ; 156(4): 294-297, 2020.
Article in English | MEDLINE | ID: covidwho-723219

ABSTRACT

Introduction: The COVID-19 pandemic has brought about a paradigm shift in healthcare. Objective: To evaluate the utility of a strategy to comprehensively address the pandemic in a health area that covers 42,000 people. Method: Between March 10 and May 15, 2020, the COVID Unit was created in the corresponding regional hospital, and an independent circuit was established for the diagnosis and management of patients with suspected or confirmed COVID-19; social health centers were monitored with PCR testing. Results: Eighteen COVID-19-positive patients (age 72.9 ± 13.2 years) were admitted, out of which 66% were males. All these patients had pneumonia and 67% had respiratory distress syndrome; no one required mechanical ventilation. Mean hospital stay was 9.4 ± 5.3 days, and mortality, 11%. PCR tests were applied to all hospital residents (n = 827) and workers (n = 519), 1,044 phone calls were made and 36 hospital admissions were avoided. Only 50 patients required close follow-up, out of which four (0.48%) were positive for COVID-19. Conclusion: Clinical monitoring at the hospital and social health centers showed that patient profile was like that documented in the literature and that the incidence of COVID-19 was low in social health centers.


Subject(s)
Clinical Laboratory Techniques , Contact Tracing , Coronavirus Infections/therapy , Hospitalization , Pneumonia, Viral/therapy , Aged , Aged, 80 and over , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Incidence , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Polymerase Chain Reaction , Respiration, Artificial/statistics & numerical data , Spain
15.
MEDICC Rev ; 22(3): 32-39, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-722917

ABSTRACT

INTRODUCTION On March 11, 2020, WHO declared COVID-19 a pandemic and called on governments to impose drastic measures to fi ght it. It is vitally important for government health authorities and leaders to have reliable estimates of infected cases and deaths in order to apply the necessary measures with the resources at their disposal. OBJECTIVE Test the validity of the logistic regression and Gompertz curve to forecast peaks of confi rmed cases and deaths in Cuba, as well as total number of cases. METHODS An inferential, predictive study was conducted using lo-gistic and Gompertz growth curves, adjusted with the least squares method and informatics tools for analysis and prediction of growth in COVID-19 cases and deaths. Italy and Spain-countries that have passed the initial peak of infection rates-were studied, and it was inferred from the results of these countries that their models were ap-plicable to Cuba. This hypothesis was tested by applying goodness-of-fi t and signifi cance tests on its parameters.RESULTS Both models showed good fi t, low mean square errors, and all parameters were highly signifi cant. CONCLUSIONS The validity of models was confi rmed based on logis-tic regression and the Gompertz curve to forecast the dates of peak infections and deaths, as well as total number of cases in Cuba. KEYWORDS COVID-19, SARS-CoV-2, logistic models, pandemic, mortality, Cuba.


Subject(s)
Coronavirus Infections/epidemiology , Forecasting/methods , Logistic Models , Pneumonia, Viral/epidemiology , Betacoronavirus , Cuba/epidemiology , Humans , Italy/epidemiology , Pandemics , Spain/epidemiology
16.
Int J Environ Res Public Health ; 17(16)2020 08 15.
Article in English | MEDLINE | ID: covidwho-717743

ABSTRACT

The COVID-19 health crisis has had a global effect, but the consequences in the different countries affected have been very different. In Spain, in a short period of time, health professionals went from a situation of stability to living with a working environment characterized by overcrowded hospitals, lack of individual protection equipment, non-existent or contradictory work protocols, as well as an unknown increase in mortality. Although in their professional activity health workers are closely linked to death processes, in recent months, working conditions and health emergencies have drawn an unheard of working scenario, with the stress and anxiety they may suffer when faced with the death of their patients. The present quantitative research was carried out in different hospitals in Spain on health professionals during the month of April 2020. Through the subscale of anxiety in the face of the death of others, developed by Collett-Lester, it has been verified that health professionals have had to develop their work in a context of precariousness, putting at risk both their individual and collective health, notably increasing anxiety in the face of the death of their patients. The predictive variables of this anxiety have been the absence of individual protection equipment, as well as high levels in the burnout subscales of emotional exhaustion and depersonalization.


Subject(s)
Anxiety/psychology , Betacoronavirus/isolation & purification , Coronavirus Infections/mortality , Coronavirus Infections/psychology , Health Personnel/psychology , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/psychology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Spain/epidemiology
17.
Int J Environ Res Public Health ; 17(16)2020 08 15.
Article in English | MEDLINE | ID: covidwho-717742

ABSTRACT

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18-31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/psychology , Internet , Life Style , Pneumonia, Viral/psychology , Quality of Life , Quarantine/psychology , Adult , Coronavirus Infections/virology , Cross-Sectional Studies , Diet/psychology , Exercise , Female , Humans , Pandemics , Pneumonia, Viral/virology , Pregnancy , Pregnant Women , Spain , Surveys and Questionnaires
18.
Int J Environ Res Public Health ; 17(16)2020 08 14.
Article in English | MEDLINE | ID: covidwho-717740

ABSTRACT

This study examines how confinement measures established during the COVID-19 pandemic crisis affected the emotions of the population. For this purpose, public sentiment on social media and digital ecosystems in Spain is analyzed. We identified affective tones towards media and citizens published on social media focusing on six basic emotions: anger, fear, joy, sadness, disgust and uncertainty. The main contribution of this work is the evidence of contagious sentiments and, consequently, the possibility of using this new dimension of social media as a form of a "collective therapy". This paper contributes to understanding the impact of confinement measures in a pandemic from the point of view of emotional health. This analysis provides a set of practical implications that can guide conceptual and empirical work in health crisis management with an alternative approach, especially useful for decision-making processes facing emergency responses and health crises, even in an unprecedented global health crisis such as the traumatic events caused by the COVID-19 disease.


Subject(s)
Anger , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Emotions , Mental Health , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Coronavirus Infections/virology , Global Health , Humans , Pneumonia, Viral/virology , Social Media , Spain/epidemiology
19.
Rheumatol Int ; 40(10): 1593-1598, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-713879

ABSTRACT

OBJECTIVE: To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. METHODS: We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. RESULTS: A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. CONCLUSION: Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.


Subject(s)
Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Coronavirus Infections/physiopathology , Glucocorticoids/therapeutic use , Hospitalization/statistics & numerical data , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Pneumonia, Viral/physiopathology , Aged , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/epidemiology , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/epidemiology , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/epidemiology , Azithromycin/therapeutic use , Betacoronavirus , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Drug Combinations , Female , Humans , Hydroxychloroquine/therapeutic use , Logistic Models , Lopinavir/therapeutic use , Lung Diseases/epidemiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/epidemiology , Male , Middle Aged , Multivariate Analysis , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Retrospective Studies , Ritonavir/therapeutic use , Severity of Illness Index , Sex Factors , Spain/epidemiology
20.
Clin Immunol ; 219: 108572, 2020 10.
Article in English | MEDLINE | ID: covidwho-713545

ABSTRACT

Human Leukocyte Antigen (HLA) includes a large set of genes with important actions in immune response against viral infection. Numerous studies have revealed the existence of significant associations between certain HLA alleles and the susceptibility and prognosis of different infectious diseases. In this pilot study we analyse the binding affinity between 66 class I HLA alleles and SARS-CoV-2 viral peptides, and its association with the severity of the disease. A total of 45 Spanish patients with mild, moderate and severe SARS-CoV-2 infection were typed for HLA class I; after that, we analysed if an in silico model of HLA I-viral peptide binding affinity and classical HLA supertypes could be correlated to the severity of the disease. Our results suggest that patients with mild disease present Class I HLA molecules with a higher theoretical capacity for binding SARS-Cov-2 peptides and showed greater heterozygosity when comparing them with moderate and severe groups. In this regard, identifying HLA-SARS-CoV-2 peptides binding differences between individuals would help to clarify the heterogeneity of clinical responses to the disease and will also be useful to guide a personalized treatment according to its particular risk.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/genetics , Histocompatibility Antigens Class I/genetics , Host-Pathogen Interactions/immunology , Pneumonia, Viral/genetics , Viral Proteins/genetics , Adult , Aged , Alleles , Betacoronavirus/immunology , Coronavirus Infections/immunology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Disease Progression , Female , Gene Expression , Gene Frequency , Histocompatibility Antigens Class I/classification , Histocompatibility Antigens Class I/immunology , Humans , Immunity, Innate , Male , Middle Aged , Pandemics , Peptides/genetics , Peptides/immunology , Pilot Projects , Pneumonia, Viral/immunology , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Protein Binding , Severity of Illness Index , Spain , Viral Proteins/immunology
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